Signs/Symptoms
Diagnosis
Lab/Imaging Findings
Treatment pt 1
Treatment pt 2
100
Clonus is the hallmark of this toxic ingestion
SSRI toxicity/serotonin syndrome
100
What overdose characteristically presents as elevated AST/ALT?
Tylenol
Timeline:
- 0-24h: incubation. Nonspecific sx (N/V, diaphoresis)
- 24-72h: latent period. RUQ pain, AST/ALT/Cr elevation
- 72-96h- peak liver toxicity. Systemic symptoms reappear, hepatic failure emerges, greatest risk of death due to cerebral edema
- 4 days-2 weeks: resolution
100
In salicylate overdose, you want to trend these 2 labs every 2 hours initially.
VBG (target pH 7.5-7.55)
Salicylate level
100
what is the first resource you to go if you have a patient that presents with a toxic ingestion?
Texas Poison Control
100
This nomogram can be used to treat what type of overdose? (Revised Rumack-Matthew Nomogram) (x-axis is time, y-axis is concentration)
Tylenol
200
Name the triad of signs/symptoms of opioid overdose
somnolence
reduced RR
miosis
200
Which toxic ingestion is this describing:
Ingestion up to 30x daily dose produces none to minor sx. Up to 50-75x daily dose can cause vomiting, CNS depression, tremor. >150x daily dose can cause fatality (hint- prescribed medication)
SSRI
200
What toxicity is this combination seen in: respiratory alkalosis with anion gap metabolic acidosis?
Salicylate toxicity (respiratory alkalosis from tachypnea, AGMA for lactic acid)
200
What is the antidote for opioid overdose and its main route of administration?
Naloxone IV
200
How often can you repeat naloxone pushes for opioid intoxication?
Every 2 minutes
(Typically start with 0.1 mg IV, can escalate doses with further pushes)
300
These 2 medication classes used to treat high blood pressure can cause hypotension, bradycardia. However, ___ causes hyperglycemia, ___ causes hypoglycemia
-CCBs
-BBs
300
name this overdose syndrome: "red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask"
anticholingeric toxicity
Sx: pupillary dilation, tachycardia, HTN, hyperthermia with dry flushed skin, urinary retention, ileus, delirium, seizures, cardiac arrythmias (QRS prolongation, QT prolongation)
300
What toxicity is this combination seen in: mixed respiratory and metabolic acidosis?
TCA overdose
CNS depression->hypoventilation, tissue hypoperfusion
300
Flumazenil is the antidote for which toxic ingestion? What is one major contraindication for this antidote?
Benzodiazepines
Chronic benzodiazepine use, high risk of seizure due to reversal
300
what are 2 treatments for salicylate toxicity?
activated charcoal
IVF
IV sodium bicarbonate (load with 1-2mEq/kg, maintenance infusion at 200 ml/hr) (check VBG q2h, target pH 7.5-7.55. stop when salicylate level drops <40, 2 levels show salicylate level is decreasing, pt asymptomatic with normal RR)
dialysis (AMS, pulm edema, high salicylate level, persistent acidosis)
400
what toxic ingestion is consistent with these signs/symptoms: tachypnea, tachycardia, diaphoresis, tinnitus, GI side effects?
salicylate/aspirin ingestion
400
The Hunter Criteria is used to diagnose which toxic ingestion?
SSRI toxicity/serotonin syndrome
84% sensitivity, 97% specificity
400
Digoxin levels should be measured ___ hours after ingestion?
6-8
(get initial, then repeat 6-8h afterwards)
**high levels don't necessarily correlate with clinical toxicity
400
what are 2 antidotes for anticholingeric toxicity?
physostigmine- 1 mg SLOWLY IV (duration of action 30-90min)
rivastigmine- 6 mg IV (duration of action 10h)
**most do well with just support care, can consider with severe/central toxicity
400
How to dose naloxone infusion for opioid intoxication?
Start with 2/3 of initial cumulative dose required for response
- E.g. if patient wakes up with 1 mg of naloxone total, start drip at 0.6 mg/hr
500
This picture was painted by Van Gogh, who who may have been using foxglove, from which ___ is derived (hint: notice the yellow tint of everything)
Digoxin
S/S:
Cardiac manifestations (Sinus bradycardia, AV block, SVT with AV block, Junctional tachycardia, Ventricular arrhythmias (chronic toxicity))
GI (N/V/D/abdominal pain)
Neurologic (delirium, fatigue)
Visual disturbances (Altered color perception, blurred vision, halos, photophobia)
500
This intoxication can be acute, acute-on-chronic, or chronic. Long-term use of this drug can cause hypothyroidism, diabetes insipidis. Toxicity can include N/V/D, movement disorders, delirium/seziures, cardiac effects.
Lithium
**treat with aggressive IVF, forced diuresis, dialysis if indicated
500
This EKG is characteristic for what overdose?
TCA (tricyclic antidepressant)
- QRS > 100ms in lead II, dominant R wave in aVR
- QRS >100 is predictive of seizures, >160 is predictive of ventricular arrythmias
500
What are the 2 strong indications for administering DSFab in digixon toxicity?
significant cardiac arrhythmia
K >6.5
**weaker indications: acute ingestion >10mg, renal failure, severe GI sx
500
Name the 2 ways sodium bicarbonate treats cardiotoxicity is TCA overdose?
1. Sodium loading (TCAs are Na channel blockers)
2. Serum alkalinization (TCA OD causes mixed respiratory and metabolic acidosis (CNS depression->hypoventilation, tissue hypoperfusion)